The Mid-term Results of Pulmonary VeinIsolation for Atrial Fibrillation associated with Mitral Valvular Heart Disease

Kim, Kyung Hwan; Kim, Tae Hun; Ahn, Hyuk

Abstract

BACKGROUND: Maze procedure, as an antiarrhythmic surgery, results in a favorable sinus conversion rate, however , the complexity and relatively longer operative time made its application difficult for all patients having atrial fibrillation. Therefore, pulmonary vein isolation(PVI) can be done for selected patients. We performed the risk factor analysis associated with sinus conversion for patients who underwent PVI procedure. MATERIAL AND METHOD: Retrospective study was done for 96 patients who received concomitant PVI procedure from October 1995 to February 1999. There were 37 males(38.5%) and 59 females(61.5%), with mean age of 46.9+/-11.6 years. Underlying valvular heart diseases were as cases of mitral stenosis(52.1%), 24 cases of mitral regurgitation(25%), and 22 cases of mitral stenoinsufficiency(22.9%). Left atrial auricle was resected and pulmonary venous encircling incision was performed after valvular procedure. Electrocardiogram and echocardiogram was performed between 6 months and 1 year after the operation. Mean follow up duration was 25.9+/-11.5 months. Analysis was done between sinus conversion group and non-conversion group. RESULT: There were 3 early deaths and 2 follow-up losses within postoperative 6 months. Early postoperative complications include 4 cases of reoperation for bleeding, 1 required ventricular assistant device, 1 stroke, 1 perioperative MI and so on. Late complications include 1 case of permanent pacemaker implantation due to sick sinus syndrome, and 1 case of transient ischemic attack. There was no valve-related complication. 75 patients(82%) converted to sinus rhythm after operation. Risk factors associated with difficulty for sinus conversion were age over 50 years(p=0.03), left atrial size more than 65 mm(p=0.03), and accompanying right heart procedure(p=0.02).
CONCLUSION
PVI can be done for selected patients with acceptable sinus conversion rate.